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This activity provides clinicians with a comprehensive review of ambulatory electrocardiogram monitoring, with emphasis on device selection, clinical indications, and interpretation of findings across a range of cardiac conditions. Despite the availability of evidence-based guidelines and an expanding array of monitoring technologies, a significant practice gap exists in the consistent application of appropriate monitoring strategies for conditions such as cryptogenic stroke, syncope, hypertrophic cardiomyopathy, and atrial fibrillation. This activity addresses that gap by equipping clinicians with updated knowledge of monitoring modalities, including Holter monitors, patch recorders, mobile cardiac outpatient telemetry, and implantable loop recorders. Participants are expected to gain improved diagnostic accuracy, enhanced risk stratification skills, and the ability to select monitoring strategies tailored to individual patient presentations, ultimately supporting better patient outcomes and more informed clinical decision-making. Objectives: Identify the clinical indications for ambulatory electrocardiogram monitoring in patients with atrial fibrillation, syncope, cryptogenic stroke, hypertrophic cardiomyopathy, and other cardiac conditions requiring extended rhythm assessment. Interpret ambulatory electrocardiogram monitoring findings to distinguish clinically significant arrhythmias from incidental findings and to guide subsequent diagnostic and therapeutic decision-making. Assess the role of ambulatory electrocardiogram monitoring in risk stratification for sudden cardiac death in patients with hypertrophic cardiomyopathy, nonischemic dilated cardiomyopathy, and other high-risk cardiac conditions. Collaborate with interprofessional healthcare team members, including cardiologists, neurologists, nurses, and pharmacists, to coordinate ambulatory electrocardiogram monitoring, communicate findings, and implement patient-centered treatment strategies. Access free multiple choice questions on this topic.

Cardiovascular diseases substantially contribute to the global burden of morbidity and mortality.[1] Arrhythmias significantly contribute to cardiovascular morbidity; most cardiac arrests and sudden cardiac deaths are secondary to arrhythmias.[2] Rapid and accurate diagnosis of dysrhythmias is essential for effective treatment, prevention of complications, and optimization of patient outcomes. Electrocardiography (ECG) is a foundational diagnostic tool that provides valuable insight into the function of the cardiac conduction system. However, traditional ECG recordings in clinical settings provide only a snapshot of cardiac activity, limiting their ability to capture intermittent or subtle abnormalities.[3] Ambulatory ECG monitoring enables continuous and prolonged surveillance of a patient's cardiac rhythm in their natural environment.[4] Ambulatory ECG monitoring employs portable devices to record and analyze cardiac electrical activity over extended periods. Continuous, prolonged monitoring is more likely to detect transient or infrequent cardiac events that may go unnoticed during short-term recordings. The prototype of ambulatory ECG monitoring is the Holter monitor, invented in 1961.[5] Ambulatory ECG monitoring has continually advanced, and multiple devices are now available to improve diagnostic yield.[6] Prolonged ambulatory ECG monitoring is uniquely poised to capture elusive arrhythmias, evaluate the efficacy of antiarrhythmic therapies, and assess overall cardiovascular health.[7] This activity reviews the various ambulatory ECG monitoring devices currently in clinical use and the indications, critical findings, and clinical significance of this testing modality.

External ambulatory ECG monitors are well tolerated and associated with few adverse effects. The most common issues are skin irritation or adhesive reactions, particularly with patch-based devices. Additional limitations include mechanical wear or device detachment, and a restricted monitoring duration due to battery capacity and data storage limits.[42] Patch recorders may also experience reduced signal quality in certain patients due to body habitus and closely spaced electrode configuration.[72]